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Choi YR, Cho Y, Park SY, Kim S, Shin M, Choi Y, Shin DH, Han JY, Lee Y. Early On-Treatment Prediction of the Mechanisms of Acquired Resistance to EGFR Tyrosine Kinase Inhibitors. Cancers (Basel) 2022; 14:cancers14061512. [PMID: 35326664 PMCID: PMC8946020 DOI: 10.3390/cancers14061512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Prediction of resistance mechanisms for epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) remains challenging. Thus, we investigated whether resistant cancer cells that expand shortly after EGFR-TKI treatment would eventually cause the resistant phenotype. METHODS We generated two EGFR-mutant lung cancer cell lines resistant to gefitinib (PC9GR and HCC827GR). The parent cell lines were exposed to short-term treatment with gefitinib or paclitaxel and then were assessed for EGFR T790M mutation and C-MET expression. These experiments were repeated in vivo and in clinically relevant patient-derived cell (PDC) models. For validation in clinical cases, we measured these gene alterations in plasma circulating tumor DNA (ctDNA) before and 8 weeks after starting EGFR-TKIs in four patients with EGFR-mutant lung cancer. RESULTS T790M mutation was only detected in the PC9GR cells, whereas C-MET amplification was detected in the HCC827GR cells. The T790M mutation level significantly increased in PC9 cells after short-term treatment with gefitinib but not in the paclitaxel. C-MET mRNA expression was only significantly increased in gefitinib-treated HCC827 cells. We confirmed that the C-MET copy number in HCC827 cells that survived after short-term gefitinib treatment was significantly higher than that in dead HCC827 cells. These findings were reproduced in the in vivo and PDC models. An early on-treatment increase in the plasma ctDNA level of these gene alterations was correlated with the corresponding resistance mechanism to EGFR-TKIs, a finding that was confirmed in post-treatment tumor tissues. CONCLUSIONS Early on-treatment kinetics in resistance-related gene alterations may predict the final mechanism of EGFR-TKI resistance.
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Affiliation(s)
- Yu-ra Choi
- Division of Translational Science, Research Institute, National Cancer Center, Goyang 10408, Korea; (Y.-r.C.); (Y.C.); (D.H.S.)
| | - Youngnam Cho
- Division of Translational Science, Research Institute, National Cancer Center, Goyang 10408, Korea; (Y.-r.C.); (Y.C.); (D.H.S.)
- Genopsy Inc., Seoul 07573, Korea
| | - Seog-Yun Park
- Department of Pathology, National Cancer Center, Goyang 10408, Korea;
| | - Sunshin Kim
- Division of Precision Medicine, Research Institute, National Cancer Center, Goyang 10408, Korea; (S.K.); (J.-Y.H.)
| | - Myungsun Shin
- Division of Convergence Technology, National Cancer Center, Goyang 10408, Korea; (M.S.); (Y.C.)
| | - Yongdoo Choi
- Division of Convergence Technology, National Cancer Center, Goyang 10408, Korea; (M.S.); (Y.C.)
| | - Dong Hoon Shin
- Division of Translational Science, Research Institute, National Cancer Center, Goyang 10408, Korea; (Y.-r.C.); (Y.C.); (D.H.S.)
| | - Ji-Youn Han
- Division of Precision Medicine, Research Institute, National Cancer Center, Goyang 10408, Korea; (S.K.); (J.-Y.H.)
- Center for Lung Cancer, National Cancer Center, Goyang 10408, Korea
- Division of Hematology and Oncology, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea
| | - Youngjoo Lee
- Division of Translational Science, Research Institute, National Cancer Center, Goyang 10408, Korea; (Y.-r.C.); (Y.C.); (D.H.S.)
- Center for Lung Cancer, National Cancer Center, Goyang 10408, Korea
- Division of Hematology and Oncology, Department of Internal Medicine, National Cancer Center, Goyang 10408, Korea
- Correspondence:
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Wang S, Luo R, Shi Y, Han X. The impact of the ALK fusion variant on clinical outcomes in EML4-ALK patients with NSCLC: a systematic review and meta-analysis. Future Oncol 2021; 18:385-402. [PMID: 34783600 DOI: 10.2217/fon-2021-0945] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Recent studies showed that ALK-fusion variants are associated with heterogeneous clinical outcomes. However, contradictory conclusions have been drawn in other studies showing no correlation between ALK variants and prognoses. Methods: A systematic review and meta-analysis was performed to evaluate the prognostic value of EML4-ALK fusion variants for patient outcomes. Results: 28 studies were included in the analysis. According to the pooled results, patients harboring variant 1 showed equivalent progression-free survival (PFS) and overall survival (OS) with non-v1 patients (hazard ratio [HR] for PFS: 0.91 [0.68-1.21]; p = 0.499; OS: 1.12 [0.73-1.72]; p = 0.610). Similarly, patients with v3 showed the same disease progress as non-v3 patients (pooled HR for PFS = 1.07 [0.72-1.58]; p = 0.741). However, pooled results for OS suggested that patients with v3 had worse survival than non-v3 patients (HR = 3.44 [1.42-8.35]; p = 0.006). Conclusion: Results suggest that patients with v1 exhibited no significant difference from non-v1 in terms of OS and PFS, while v3 was associated with shorter OS in ALK-positive patients with non-small cell lung cancer.
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Affiliation(s)
- Shasha Wang
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Rongrong Luo
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
| | - Xiaohong Han
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, State Key Laboratory of Complex Severe & Rare Diseases, NMPA Key Laboratory for Clinical Research & Evaluation of Drug, Beijing Key Laboratory of Clinical PK & PD Investigation for Innovative Drugs, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100032, China
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